The relationship between clinical measurements and gait analysis data in children with cerebral palsy.

Spasticity is a common impairment that interferes with motor function (particularly gait pattern) in children with cerebral palsy (CP). Gait analysis and clinical measurements are equally important in evaluating and treating gait disorders in children with CP. This study aimed to explore the relationship between the spasticity of lower extremity muscles and deviations from the normal gait pattern in children with CP. Thirty-six children with spastic CP (18 with spastic hemiplegia [HS] and 18 with spastic diplegia [DS]), ranging in age from 7 to 12 years, participated in the study. The children were classified as level I (n=24) or level II (n=12) according to the Gross Motor Function Classification System. Spasticity levels were evaluated with the Dynamic Evaluation of Range of Motion (DAROM) using the accelerometer-based system, and gait patterns were evaluated with a three dimensional gait analysis using the Zebris system (Isny, Germany). The Gillette Gait Index (GGI) was calculated from the gait data. The results show that gait pathology in children with CP does not depend on the static and dynamic contractures of hip and knee flexors. Although significant correlations were observed for a few clinical measures with the gait data (GGI), the correlation coefficients were low. Only the spasticity of rectus femoris showed a fair to moderate correlation with GGI. In conclusion, the results indicate the independence of the clinical evaluation and gait pattern and support the view that both factors provide important information about the functional problems of children with CP.

Domagalska M ，Szopa A ，Syczewska M ，Pietraszek S ，Kidoń Z ，Onik G ... -  《-》

Quadriceps femoris spasticity in children with cerebral palsy: measurement with the pendulum test and relationship with gait abnormalities.

Szopa A ，Domagalska-Szopa M ，Kidoń Z ，Syczewska M ... -  《Journal of NeuroEngineering and Rehabilitation》

Which functional impairments are the main contributors to pelvic anterior tilt during gait in individuals with cerebral palsy?

While past investigations focused on describing pelvic motion patterns in the frontal and transversal plane, the sagittal plane "double bump" pattern commonly found in children with cerebral palsy was only rarely investigated, especially concerning the underlying pathology. 375 ambulatory (GMFCS I-III) patients with bilateral spastic cerebral palsy were included in this study. Gait and clinical data (ROM, strength, spasticity) were classified in two different ways: (a) into two groups of normal and enhanced mean anterior pelvic tilt and (b) into two groups of moderate and excessive ROM in pelvic tilt. The results reveal that increased mean pelvic tilt is mainly associated with gait features of reduced hip extension and increased pelvic and trunk obliquity ROM but with increased knee ROM. In the clinical exam this corresponds to a smaller passive knee extension deficit and reduced knee flexor strength. It seems that flexors to extensors strength imbalance at the knee is a major feature why mean pelvic position is tilted anterior whereas maximum passive hip extension is of minor importance. Contrarily, excessive sagittal pelvic ROM is associated with increased knee flexion at initial contact and reduced knee ROM. Furthermore, Duncan-Ely- and Tardieu-tests show both increased values in this group with excessive pelvic range of motion indicating for spastic rectus femoris activation. The results of our study indicate that the two gait variables are influenced by different specific mechanisms which are now described for the first time. Since the pelvis plays a central role during gait, these findings should be considered when planning single event multilevel surgery in patients with cerebral palsy.

Wolf SI ，Mikut R ，Kranzl A ，Dreher T ... -  《-》

Relationship of spasticity to knee angular velocity and motion during gait in cerebral palsy.

Damiano DL ，Laws E ，Carmines DV ，Abel MF ... -  《GAIT & POSTURE》

Dynamic spasticity determines hamstring length and knee flexion angle during gait in children with spastic cerebral palsy.

Previous researchers reported that popliteal angle did not correlate well with knee angle during gait in individuals with spastic cerebral palsy (CP). To determine if hamstring spasticity, as measured by Modified Tardieu Scale (MTS) at rest, is associated with knee flexion angle at initial contact and midstance during gait. Thirty ambulatory children (mean age 8.7 ± 2.4 years) diagnosed with spastic CP participated. The hamstrings' spasticity was assessed in the supine position with the MTS, measuring R1 (muscle reaction to passive fast stretch), R2 (passive range of motion), and R2-R1 (dynamic component of spasticity). We conducted 3-dimensional computerized gait analysis and calculated semimembranosus muscle-tendon length and lengthening velocity during gait using musculoskeletal modeling and inverse kinematic analysis by OpenSim. Pearson correlation coefficients were calculated to estimate the association of MTS with biomechanical parameters during gait. Knee flexion angle at initial contact and maximal knee extension angle during stance phase significantly positively correlated with both R1 and ㅣR2 - R1ㅣ of MTS, but not with R2 angle. The length of semimembranosus at initial contact, end of swing, and minimal length during stance phase were strongly negatively associated with R1, rather than R2 or ㅣR2 - R1ㅣ angles. The R1 angle of MTS (muscle reaction to passive fast stretch) is more relevant correlate of knee flexion angle during gait than the R2 (passive range of motion).

Choi JY ，Park ES ，Park D ，Rha DW ... -  《-》